Benefits of primary prophylaxis with letermovir in patients after allogeneic hematopoietic stem cell transplantation for hematologic malignancies.

BACKGROUND

Introduction of letermovir (LMV) as prophylaxis for cytomegalovirus (CMV) infection has decreased the number of clinically significant CMV infections (cs-CMVi) in allogeneic hematopoietic stem cell transplantation (HSCT) recipients. However, long-term, real-world data on LMV's impact on post-transplant outcome remain scarce.

RESEARCH DESIGN AND METHODS

The aim of our study was to evaluate clinical outcome of 93 CMV-seropositive patients who received LMV prophylaxis and to compare them to 168 LMV-free recipients.

RESULTS

CMV reactivation was less frequently observed in LMV group if compared to LMV-free control. Twelve patients (17%) and 71 (42%) reactivated CMV in LMV-treated and LMV-free patients, respectively. The cumulative incidence of cs-CMVi was lower in LMV group compared to control [37% 63%]. The incidence of severe acute graft-versus-host disease (aGVHD) was also lower in LMV-treated patients (6% 21%). Overall survival, non-relapse mortality and progression-free survival at 24 months were comparable. No risk factors for post-transplant CMV reactivation were identified in LMV group, whereas unrelated donor, donor-negative/recipient-positive CMV-serostatus, and presence of severe aGVHD were associated with higher risk of CMV reactivation in LMV-free control.

CONCLUSIONS

LMV as CMV primary prophylaxis has a beneficial effect on post HSCT outcome decreasing the incidence of severe aGVHD and cs-CMV reactivation.